I THINK MUCH of my empathic ability is rooted in my upbringing in Ghana, a country in West Africa where I was born and lived until I moved to Pennsylvania for my internal medicine residency. My mother was an elementary school teacher, and my father worked as the manager of a shipping company, so I grew up in a stable middle-class home. My dad was a good provider, but he traveled extensively for work, so my mom was the glue that held our family together. Being a teacher, she emphasized education above just about everything else and assigned me additional schoolwork at home. As a result, my siblings and I all pursued higher education and professional careers in Ghana, the United Kingdom, or the United States. I was steered toward medicine from an early age, as many of the best students in Ghana are. My parents knew I had the potential to succeed as a doctor. In addition to being steered toward a medical career, I also naturally developed a great interest in medicine that intensified as I witnessed the difficulties that many Ghanaians experienced in seeking health care.
Life in Ghana and the political system there are relatively stable, unlike some other African nations, where ethnic and religious tensions breed violence and fear. Most Ghanaians have reliable access to food, shelter, and public education. However, life there is not nearly as affluent as the average US life, particularly concerning health care. Ghana has a universal health care system that has evolved extensively over the past several decades. In the 1980s, the government began the “cash and carry” system, which required Ghanaians to pay out-of-pocket fees at each point of service. This system excluded many people in the lower and middle classes who could not afford the fees. In the early 2000s, the ruling government launched the national Health Insurance Scheme, which provided universal health care to all Ghanaians for about 6% of the gross domestic product. Nonetheless, health care remains variable throughout the country, with urban areas having greatest access to hospitals, clinics, and pharmacies and rural areas having little or no modern care. Patients in rural areas still either rely on traditional African medicine or travel great distances for care. As I grew up and attended medical school in Ghana, I witnessed these inequities, which shaped my approach to medical practice.
FIRST- AND THIRD-WORLD PROBLEMS
One of the things I remember most about medical school was caring for patients with sickle-cell disease, an affliction common to Africa that causes bone pain and pain in solid organs due to sticking of blood in small vessels. Sickle-cell patients in Ghana suffer tremendously because they do not have access to good pain medication. In fact, opioids are almost nonexistent in Ghana and in most other developing nations for cultural, social, and political reasons. When I was in medical school, the strongest ...